Child Mortality

Since the beginning of the age of the Enlightenment and over the course of modernization, the mortality of children below 5 years of age has declined rapidly. Child mortality in rich countries today is much lower than 1%. This is a very recent development and was only reached after a hundredfold decline in child mortality in these countries. In early-modern times, child mortality was very high; in 18th century Sweden every third child died, and in 19th century Germany every second child died. With declining poverty and increasing knowledge and service in the health sector, child mortality around the world is declining very rapidly. Big countries like Brazil and China reduced their child mortality rates 10-fold over the last 4 decades. Other countries – especially in Africa – still have high child mortality rates, but its not true that these countries are not making progress. In Sub-Saharan Africa, child mortality has been continuously falling for the last 50 years (1 in 4 children died in the early 60s – today it is less than 1 in 10). Over the last decade this improvement has been happening faster than ever before. Rising prosperity, rising education and the spread of health care around the globe are the major drivers of this progress.

In the time series plot below I show child mortality over the long run. Today child mortality in industrialized countries is below 5 per 1,000 live births. The time series plot shows that these low mortality rates are a very recent development, and in pre-modern countries child mortality rates were between 300 and 500 per 1,000 live births. In the late 19th century, every second child in Germany died before its fifth birthday. In developing countries the health of children is quickly improving – but child mortality is still much higher than in developed countries.

A second interesting characteristic that is immediately noticeable is that the series are very ‘spikey’ in the 19th century and are then much smoother in the 20th century. This is partly because the data quality is improving over time but it also shows how frequent crises were in pre-modern times. The decline of crises is an important aspect of improving ‘living standards’. In the ‘Our World in Data’ entry on food price volatility you find a long-run series of food price volatility in Pisa that shows how frequent food crises were. In the following plot you can see what these and other crises – epidemics or wars, for example – meant for the health of the population.

The chart shows the child mortality rate – the share of children dying before they reach the age of 5 – for the entire world population at 4 different points in time.

How to read the following graph: On the x-axis you find the cumulative share of the world population. The countries are ordered along the x-axis descending by the country’s child mortality rate. This makes it possible to see the child mortality rate for each country. Some countries are labelled, but not all. It is also possible to see which share of the world population had a child mortality rate lower than a given level. For the orange line – referring to data from 1950-60 – we see that close to 70% of the world population have a child mortality rate of higher than 10% back then.

For 1800 (red line), you see that the countries on the very left – Yemen, India, and others that are not labelled – had a child mortality rate higher than 50%. Every second child died before the age of 5. On the very right of the red line you see that in 1800 the best-off countries in the world had a child mortality rate higher than 30%: Every third child died in the countries with the best health.

Looking at the orange line, you see that in the following 150 years some countries substantially reduced their child mortality rate: 30% of the world population has a child mortality under 10%. Other countries were stuck in poor health: More than half of the world (57%) had child mortality that were still higher than 20%. The world was clearly divided into developed and developing countries. The rapid progress of the industrialized countries had the consequence that the distribution of global health was hugely unequal.

The latest data refers to 2013. Global health has improved hugely. Particularly those countries that had the worst health in the 1950s experienced the most dramatic improvements. China for example reduced its child mortality from 28.4% to now 1.3%. The consequence of the faster progress in former developing countries is that global health inequality has fallen since the 1950s.

The global average child mortality rate (weighted population) was 43.3% in 1800 and now fell to 3.4%. Focusing at global inequality we see that in 1800 health was bad around the world, in the 1950s the world became unequal, and today we are back to higher equality but on a much higher level.

Comparing the position of countries on the red, orange, green and blue lines also makes it possible to see the change in a single countries: In 1800 every second child in South Korea died, in the 1950s the rate was halved (26%), and today it is down to 2.7%.

World population by level of fertility over time, 1950-2050 – Max Roser1

In ‘Longevity Among Hunter‐Gatherers’ the authors, Gurven and Kaplan, compare mortality patterns of hunter gatherers and modern societies and state that “infant mortality is over 30 times greater among hunter-gatherers, and early child mortality is over 100 times greater than encountered in the United States”.2

Below we can see that the annual rates of reduction in child mortality is decreasing or leveling off in most regions around the world except for Sub-Saharan Africa, where the rate is decreasing more and more each year.

Infectious disease during and after the neonatal period is a major cause of child death. Other neonatal issues like birth complications also are major causes. The pie chart below breaks down these different causes.

# Global distribution of deaths among children under age 5, by cause, 2012 – UNICEF (2013)7

Progress is being made to eradicate the most common causes of child death, however, as demonstrated by this bar chart.

As one would expect, income level of the country is extremely correlated with child mortality rate. The poorest countries have the highest levels of child mortality, and the countries with the highest income have the lowest rates. This relationship has remained the same even as child mortality has decreased around the world, as demonstrated below.

# Under five mortality rate (per 1,000 live births) and total fertility rate (births per woman), 1970 to 2010 – World Development Indicators (2013)10

The effect of education on child mortality for a sample of 175 countries was analyzed in a research paper published in The Lancet. The authors found that around half (51.2%) of the reduction in child mortality between 1970 and 2009 could be attributed to increased educational attainment in women of reproductive age.11 Below we can see that educational attainment by women contributes to the decrease in child mortality rates within countries as well. For instance, Niger has the highest national average of child mortality, but within the country, mothers with a secondary school education or higher experience child mortality rates that are lower than the national averages of the next 16 countries listed.

The effect of education on child mortality is huge. Especially in places with relatively little education, the prospects for extending education are promising. In 2008, 4.4 million children younger than 5 years died in sub-Sahran Africa. The UNESCO estimates that an extension of secondary education for all women would save 1.8 million children per year.13

In a publication in the American Economic Journal the authors report that Thailand’s 2001 healthcare reform led to significant reductions in child mortality, especially among the poor.14 The following graph shows for a large cross-section of countries that high expenditure on health more generally comes along with lower levels of child mortality.

# Under-five mortality rate by per capita total expenditure on health, countries by WHO Region, 2002–2003 – WHO15

Child mortality is the probability per 1,000 live births that a newborn baby will die before reaching age five under current age-specific mortality patterns. The uncertainty associated with the estimates of child mortality can be understood if one compares different data sources. The UN Inter-agency Group for Child Mortality Estimation does this for each country of the world. Here is the chart on the child mortality of Brazil as one example. On the same website the differences between various data sources can be studied for a large number of countries.

Preston (1995) – Human mortality throughout history and prehistory. In Simon (1995) – The State of Humanity. Wiley.

Johnston, F. E., and C. E. Snow (1961) – The Reassessment of the Age and Sex of the Indian Knoll Skeletal Population: Demographic and Methodological Aspects, American Journal of Physical Anthropology, vol. 19.

The sources of Gapminder are the Human Mortality Database and Child Mortality Estimates Info. Some of the data on child mortality is estimated from data on infant mortality (see the documentation which is online here).

The data is taken from the World Bank and shows ‘Mortality rate, under-5 (per 1,000 live births)’ – it is online here http://data.worldbank.org/indicator/SH.DYN.MORT. The World Bank’s definition of world regions can be found here. The World Bank’s source are the estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) available at www.childmortality.org (but only by country and not by world region).

The data is taken from UNICEF’s www.childmortality.org and are estimates generated by the UN Inter-agency Group for Child Mortality Estimation (IGME) in 2013.

This is taken from UNICEF (2013) – Committing to Child Survival: A Promise Renewed – Progress Report 2013. Online here.

This is taken from UNICEF (2013) – Committing to Child Survival: A Promise Renewed – Progress Report 2013. Online here.

The data is taken from the World Bank and shows ‘Mortality rate, under-5 (per 1,000 live births)’ – it is online here http://data.worldbank.org/indicator/SH.DYN.MORT. The World Bank’s definition of country groups by income level can be found here. The World Bank’s source are the estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) available at www.childmortality.org (but only by country and not by world region).

The source is World Bank (2013) – World Development Indicators 2013. Washington, DC: World Bank. doi: 10.1596/978-0-8213-9824-1. It is online here. The World Bank licensed this work under the Creative Commons Attribution 3.0 Unported license (CC BY 3.0). Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes.

The source is UNESCO (2011) EFA Global Monitoring Report – The hidden crisis: Armed conflict and education. The report is online here. Note: Data are for the most recent year available during the period specified. The UNESCO’s original source is ICF Macro (2010).

Gruber, Jonathan, Nathaniel Hendren, and Robert M. Townsend (2014) – “The Great Equalizer: Health Care Access and Infant Mortality in Thailand.” American Economic Journal: Applied Economics, 6(1): 91-107. The journal’s website for the publication is here another version is is available here.

This is taken from the WHO here. The WHO remains the copyright holder.

The book by Gy. Acsádi and J. Nemeskéri was translated by K. Balas and published by Akadémiai Kiadó (Budapest. 1970, 346 pp.)

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